ESBD_571771_1793048003819_HHS0018027v2 - Exhibit D Bidder Reference_Qualifications.pdf
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- Attached to
- Dental Anesthesiologist Services at Lubbock SSLC
- Solicitation number
- HHS0018027v2
- Issued by
- Texas
About this file
This is an Exhibit D Bidder Reference and Contract Qualifications Form for a Dental Anesthesiologist Services contract at Lubbock SSLC in Texas (HHS0018027v2, dated 1/21/26). The form requires bidders to submit comprehensive qualifications documentation including a minimum of three verifiable references for contracts of similar size and scope completed within the last five years. For each reference, bidders must provide the business name, point-of-contact information, address, phone, email, whether services were provided as prime contractor or subcontractor, and a detailed description with dates of services performed.
The form additionally requires bidders to provide company background information such as years in business, office address, current staffing levels (permanent full-time, part-time, and total employees), and geographic operating limits. Bidders must document all industry certifications, qualifications, formal training programs, and applicable licenses held by staff assigned to service the account. The form requires a one-page narrative describing bidder experience and qualifications, a written description of operational size and scope including employee availability for customer service and order fulfillment, and identification of at least two 24-hour emergency contacts. Supporting documentation for all referenced contracts must be attached to the bid response.
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Text version
Exhibit D – Bidder Reference and Contract Qualifications Form – 1/21/26
HHS0018027v2
Exhibit D – Bidder Reference and Contractor Qualifications Form
Bidders must provide a minimum of three (3) verifiable references for contracts of similar size and scope of services within the last five (5) years.
For each reference, provide the following and attach to the Response any documentation to support the information regarding current or prior contracts.
1. Business Name:
Point-of-Contact Name and Title:
Address (City, State, Zip):
Phone:
Email address:
Services Performed as Prime Contractor or as Subcontractor?
[Prime Contractor] or [Subcontractor]
Description and Dates of Services Provided:
2. Business Name:
Point-of-Contact Name and Title:
Address (City, State, Zip):
Phone:
Email address:
Services Performed as Prime Contractor or as Subcontractor?
[Prime Contractor] or [Subcontractor]
Description and Dates of Services Provided:
3. Business Name:
Point-of-Contact Name and Title:
Address (City, State, Zip):
Phone:
Email address:
Services Performed as Prime Contractor or as Subcontractor?
[Prime Contractor] or [Subcontractor]
Description and Dates of Services Provided:
Additional Company Information:
Number of Years in Business:
Office Address:
Current Number of Permanent, Full-Time Employees:
Current Number of Permanent, Part-Time Employees:
Current Total Number of Employees:
Geographic Limits of Operations:
List any Industry Certifications/Qualifications/Formal Training Programs that your staff (who will be servicing this account) have been certified in:
Name Certifications/Qualifications/Formal Training
List any applicable licenses currently held by staff that will service this account:
Name License Number
Bidder’s Minimum Experience and Qualifications- Section 7.1.5
Provide a narrative (maximum of one page) describing the bidder’s experience and qualifications as it applies to this Section.
Demonstration of the Ability to Perform
Provide a written description of the size and scope of all operations, including the number of Bidder’s employees available to provide customer service, order fulfillment, safe shipping and handling of product and the number of supervisors for each location, as applicable.
24-Hour Contacts – Must list a minimum of 2:
Contact 1
Name
Phone
Contact 2
Name
Phone
File details come from the government source that posted it. Updated .